MEDICARE: MRS. TERESA OSTDIEK M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP-9381-SL	MA
2	235Z00000X	Speech-Language Pathologist	1697	NE

General Provider Information

NPI Number	:	1457753105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA OSTDIEK M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	50 SAINT PETER ST
Second Line	:	APARTMENT 302
City	:	SALEM
State	:	MA
Zip	:	01970-4062
Country	:	US
Telephone Number	:	308-249-0209
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 SAINT PETER ST
Second Line	:	APARTMENT 302
City	:	SALEM
State	:	MA
Zip	:	01970-4062
Country	:	US
Telephone Number	:	308-249-0209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/24/2014

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Directions to “ MRS. TERESA OSTDIEK M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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